Hypothyroidism Treatment

Treatment of hypothyroidism depends on many factors. Leading and apparently the only academic foundation for hypothyroidism treatment is hormone replacement therapy. This means that with the lack of hormones they are administered artificially.  The dose is selected individually depending on a specific case and involves taking hormone medication. Depending on the reasons contributing to hypothyroidism and body conditions, a patient maybe prescribed medication for a few months, a few years or for life.

In the case of iodine deficiency, iodine can be prescribed in the form of appropriate medication at adequate doses. It should be pointed out that self treatment with iodine can be harmful. This is due to the fact that iodine activity can have a negative impact on functional pressure of the thyroid and cause deterioration of its condition.

One of the hormones, widely use for hypothyroidism treatment, is thyroxine in tablet form. Despite the fact that the dosage is administered individually, there is a certain average value in the hormone requirements. Thus, the adult requirement for L-thyroxine is 1.5 micrograms per 1 kilogram of body weight. In pregnant women the dose should be increased by 25-50% with regular monitoring of free L-thyroxine levels in the blood. The medication should be taken only once before breakfast and before taking any other medications. Absorption of L-thyroxine is influenced by many substances (especially iron supplements, sucralfate, aluminum hydroxide etc). In older people (men over 40 and women over 50), and all patients with cardiovascular disorders, it is recommended to start with ¼ of required dose for 10-14 days. Every two weeks the dose should be increased by ¼, bringing it to adequate. In the case of co-existing endocrinopathy, particularly related to adrenal cortex, it is first necessary to adjust cortisol levels, and then gradually add thyroxine.

Hyperthyroidism, or increased thyroid function, can be treated with medications, if it was caused by autoimmune process with the formation of toxic goiter. The medications influence the production of thyroid hormones. They are quite effective, but have a certain number of side effects. Among most serious side effects are reduction of granulocytes in the blood, up to complete suppression of their production (agranulocytosis), reduced patalet count (thrombocytopenia), and the development of jaundice (due to toxic hepatitis). Complications are very infrequent, only in 1-3 out of every 1000 patients. Medication cycle should be at least 12 months, preferably 12-24 months. When the medication treatment is over, 50% of patients reach remission – the symptoms are gone and there’s no further need for the medication. In case the disease resurfaces (happens in about 50% of patients respectively), the cycle can be repeated. If the remission still not attained, the patient is send for a more radical treatment (surgery or radioactive iodine therapy).

Surgical treatment of thyroid disorders

During surgical treatment the thyroid tissue is partially or completely removed. Of course, the complete removal of thyroid is the mostly preferred extend of surgical intervention. However, due to the close proximity of structures such as laryngeal nerve, blood vessels and parathyroid glands, the surgeon always has to the keep a small part of the tissue intact. The operation is performed under general anesthesia and preferably in an institution that performs these types of surgeries on a regular basis. Using modern techniques, the risk of complications is very low, the discomfort from the surgery and hospital stay are very short. The surgical treatment of Grave’s disease is only administered in the cases of relapse after medication treatment, and also in the cases of medication intolerance (severe allergic reactions, hepatitis, agranulocytosis). Surgery during hyperthyroidism may be the only option in pregnant women, when the medication treatment is too risky.

Thyroid tumors, especially malignant neoplasms are subject to surgical treatment, followed by application of ablative doses of radioactive iodine.